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Clinical characteristics and computed tomography findings of pulmonary toxoplasmosis after hematopoietic stem cell transplantation

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Abstract

The prognosis of pulmonary toxoplasmosis, including disseminated toxoplasmosis involving the lungs, following hematopoietic stem cell transplantation (HSCT) is extremely poor due to the difficulties associated with early diagnosis and the rapidly progressive deterioration of multiorgan function. In our institution, we identified nine cases of toxoplasmosis, representing incidences of 2.2 and 19.6 % among all HSCT recipients and seropositive HSCT recipients, respectively. Of the patients with toxoplasmosis, six had pulmonary toxoplasmosis. Chest computed tomography (CT) findings revealed centrilobular, patchy ground-glass opacities (n = 3), diffuse ground-glass opacities (n = 2), ground-glass opacities with septal thickening (n = 1), and marked pleural effusion (n = 1). All cases died, except for one with suspected pulmonary toxoplasmosis who was diagnosed by a polymerase chain reaction assay 2 days after the onset of symptoms. In pulmonary toxoplasmosis, CT findings are non-specific and may mimic pulmonary congestion, atypical pneumonia, viral pneumonitis, and bronchopneumonia. Early diagnosis and treatment is crucial for overcoming this serious infectious complication. Pulmonary toxoplasmosis should be considered during differential diagnosis in a recipient with otherwise unexplained signs of infection and CT findings with ground-glass opacities, regardless of the distribution.

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Authors and Affiliations

  1. Department of Hematology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, Nagano, 380-8582, Japan

    Masahiko Sumi, Hiroko Kaiume, Wataru Takeda, Takehiko Kirihara, Taro Kurihara, Keijiro Sato, Toshimitsu Ueki, Yuki Hiroshima & Hikaru Kobayashi

  2. Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan

    Kazumi Norose & Kenji Hikosaka

  3. Respiratory Division, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, 380-8582, Japan

    Hiroshi Kuraishi

  4. Department of Pathology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, 380-8582, Japan

    Masahide Watanabe

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  1. Masahiko Sumi
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  2. Kazumi Norose
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  3. Kenji Hikosaka
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Correspondence to Masahiko Sumi.

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Sumi, M., Norose, K., Hikosaka, K. et al. Clinical characteristics and computed tomography findings of pulmonary toxoplasmosis after hematopoietic stem cell transplantation. Int J Hematol 104, 729–740 (2016). https://doi.org/10.1007/s12185-016-2077-0

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  • DOI: https://doi.org/10.1007/s12185-016-2077-0

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